PROJECT SUMMARY ABSTRACT Stroke is a leading cause of disability in the United States. Most stroke survivors have difficulty performing daily activities and participating in the community. Efficacy of interventions that address the chronic needs of stroke survivors has been identified as a high priority for stroke research. A gap in care exists at the point of transition from inpatient rehabilitation (IR) to home, when survivors encounter new environmental barriers due to the cognitive and sensorimotor sequelae of stroke. Resolving these barriers and improving independence in the community have potential to significantly improve stroke survivors? long-term morbidity. The proposed study investigates the efficacy and safety of a novel enhanced rehabilitation-transition program to reduce environmental barriers and improve daily activity performance and community participation. Community Participation Transition after Stroke (COMPASS) uses 2 complimentary evidence-based interventions: home modifications and strategy training delivered in the home. Home modifications provide environmental support to compensate for impairments. Strategy training enables patients to identify and prioritize ADL problems, identify barriers to performance, and develop strategies to resolve barriers. The complementary effects of these therapies at a novel point of care offer a robust intervention for a current service gap. The primary aim of this phase IIb, single-blind, parallel-group, randomized controlled trial is to investigate the efficacy of COMPASS during the transition from IR to home. Participants will be randomized to receive either COMPASS or attentional control. We hypothesize that COMPASS participants will demonstrate significant improvements in community participation and ADL performance and significant reduction in environmental barriers versus control. In preparation for a phase III multicenter trial, we will explore additional candidate study endpoints and establish intervention safety by examining the rates of falls and hospital readmissions. Finally, we will conduct a process evaluation examining outcomes such as reach, cost, fidelity, and adherence to aid interpretability of the trial and implementation. The aims fill critical gaps in stroke rehabilitation evidence by investigating the efficacy, safety, and implementation of an intervention targeting the transition from an acute to chronic condition. The results of this trial will provide important information about the long-term participation and environmental barriers of stroke survivors. The project has the potential to resolve the significant unmet need of disability after stroke.